THE A.U.P.E. MULTI-PURPOSE CO-OPERATIVE SOCIETY LIMITED
 73 BRAS BASAH ROAD #03-01 NTUC TRADE UNION HOUSE SINGAPORE 189556
TEL: 63365440 Fax: 63367741
HOSPITALISATION BENEFITS CLAIM FORM CLAIM NO.      
1. ELIGIBILITY  
a) All members of the AUPE Multi-Purpose Co-operative Society Ltd who have fully paid up
subscription and are not in arrears of any loan repayments during the time of claiming.
b) Member must be hospitalised in a Government Restructured Hospital or a recognised private hospital.
2. MEMBER'S PARTICULARS  
FULL NAME (Mr/Mrs/Miss/Mdm)*              
Alias (If any)             Date of Birth      
NRIC NO.             Sex: Male/Female*
Home Address                    
       
              Singapore ( )
Telephone (Home)     Office       Handphone    
Date Joined Society:           Membership No:    
Place of employment:                
Period of Hospitalisation:
From     To     Total No of Days
and Amount		      
Name of Hospital during admission              
3. SUPPORTING DOCUMENTS  
Member must attach this claim form  with the bill from the hospital indicating the ward charges
payable OR a letter from the hospital indicating he/she has been hospitalised for the said period.
               
SIGNATURE OF MEMBER DATE
                   
NAME OF STAFF/SIGNATURE OF STAFF CLAIM CERTIFIED AND APPROVED
* Delete whichever not applicable